Obsessive-compulsive disorder (OCD) is characterized by the presence of unwanted and repetitive thoughts triggering significant anxiety, as well as the presence of ritual behaviors or mental acts carried out in response to obsessions to reduce the associated distress. In the contamination subtype, individuals are scared of germs and bacteria, are excessively concerned with cleaning, fear contamination and the spread of disease, and may have a very strong aversion to bodily secretions. A few studies on virtual reality (VR) have been conducted with people suffering from OCD, but they all focus on the subtype characterized by checking rituals. The goal of this study is to confirm the potential of a "contaminated" virtual environment in inducing anxiety in 12 adults suffering from contamination-subtype OCD compar ed to 20 adults without OCD (N = 32) using a within-between protocol. Subjective (questionnaire) and objective (heart rate) measurements were compiled. Participants were immersed in a control virtual environment (empty and clean room) and a "contaminated" virtual environment (filthy public restroom) designed for the treatment of OCD. Immersions were conducted in a 6-wall CAVE-like system. As hypothesized, the results of repeated-measures ANCOVAs revealed the significant impact of immersion in a filthy public restroom for participants suffering from OCD on both measures. Presence was correlated with anxiety in OCD participants and no difference in presence was observed between groups. Unwanted negative side effects induced by immersions in VR were higher in the OCD group. The clinical implications of the results and directions for further studies are discussed.

Obsessive–compulsive disorder (OCD) is characterized by the presence of distressing, recurrent and intrusive thoughts, impulses, or doubts as well as behavioral or mental rituals. OCD has various subtypes, including the fear of contamination in which individuals fear bacteria, germs, disease, or bodily secretions, and engage in clinically significant cleaning and avoidance rituals. Cognitive–behavioral therapy (CBT) is an effective treatment for OCD and involves, among other therapeutic strategies, exposing patients to feared stimuli while preventing them to engage in compulsive behaviors. In recent years, virtual reality (VR) has shown the potential of in virtuo exposure with people suffering from anxiety disorders and OCD. The objective of this pilot study is to examine the effectiveness of a CBT program where exposure in conducted in virtuo. Three adults suffering from OCD with a dominant subtype of contamination were enrolled in a single-case design with multiple baselines across participants. The presence and intensity of obsessions and compulsions were assessed daily during baselines of 3-, 4-, or 5-week, and a 12-session treatment. Follow-up information was gathered after 4 and 8 months. Treatment outcome is assessed with visual inspection of the graphs and ARMA time-series analyses. Clinical information, self-reports, and details of the treatment are provided for each patient. Statistical analyses for the time-series data revealed a statistically significant improvement in all three participants, but global improvement is considered positive for only two. This study innovates in proving preliminary support for the usefulness of VR in the CBT of OCD with contamination features.

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